Guides you through decision to use chemotherapy for early-stage breast cancer. Lists reasons for and against chemotherapy. Covers side effects. Includes interactive tool to help you make your decision.

Breast Cancer: Should I Have Chemotherapy for Early-Stage Breast Cancer?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Your options

Key points to remember

Chemotherapy ("chemo") is often used after surgery for
early-stage breast cancer to help lower the chances that your breast cancer
will come back.

Some women have a very low risk of cancer coming back and don't need chemo. There are gene tests that may show whether having chemo will
help you reduce your chances that the cancer will return.

Your age, type of cancer, tumor size, and hormone
receptor status have an effect on how well chemo will work to keep your cancer
from coming back.

Different medicines used for chemo have different
side effects. Your doctor can give you other medicines to help you deal with
side effects like nausea and vomiting. Some women are bothered a lot by the
side effects, but some aren't.

The drugs used for chemo can be very expensive. Insurance
policies don't always cover the whole cost. If you have no insurance, your
doctor may be able to help you find drug companies or organizations that will
help you pay for this treatment.

Breast cancer occurs when abnormal cells grow out of control in one or both
breasts. These cells can invade nearby tissues and form a mass, called a
malignant tumor. The cancer cells can spread (metastasize) to the
lymph nodes and other parts of the body.

The first treatment for early-stage breast cancer usually
includes surgery and sometimes
radiation. Your doctor may also talk to you about
added treatment, such as
chemotherapy ("chemo") and
hormone therapy, that may help keep cancer from coming
back.

Some people think of added treatment as an insurance policy
designed to destroy any cancer cells that may still be in the body.

It isn't possible for all women to know for
sure who will benefit from added treatment. But if you have early-stage,
estrogen receptor positive (ER+) breast cancer with no cancer in the lymph
nodes, you may have a gene test. Gene tests, such as the Oncotype DX, may be
done on the cancerous tissue that was removed to look for
tumor markers. These tests can give your doctor
important information about whether chemotherapy will help you.

The type of added treatment you have depends on the
stage and
classification of your breast cancer:

Stage: How far the
cancer has spread in your breast and whether it has spread to nearby tissues or
other organs is called the stage. This is one of the most important things in
choosing the treatment option that is right for you. If breast cancer cells
have spread to your lymph nodes, there is a greater risk that they may also
have spread to other places in your body. Added treatment, including chemo, may
help destroy cancer cells in your body.

Classification: Breast cancer is classified according to what
the cancer cells look like under a microscope. This tells your doctor how fast
the cancer cells are growing and dividing and where they may have started in
the breast tissue. If your cancer cells are growing and dividing quickly, then
chemo may help you. When cancer is the kind that grows quickly, doctors call it
"aggressive" or "poorly differentiated."

Different
chemotherapy medicines tend to cause different side effects. Many women do not
have problems with these side effects, while other women are bothered a lot.
There are other medicines you can take to treat the side effects of
chemo.

Talk to your doctor about the type of chemotherapy medicine
that he or she is planning to give you. Ask about any side effects that the
chemo may cause.

Short-term side effects can include:

Nausea and vomiting.

Loss of
appetite.

Fatigue.

Hair thinning or hair loss.

Mouth
sores.

Diarrhea.

Increased chance of bruising,
bleeding, and infection.

Memory and concentration problems.

Long-term side effects of chemotherapy can
include:

Early menopause, which means not being able
to have children anymore. It also can include symptoms like hot flashes,
vaginal dryness, and thinning bones (osteoporosis).

Concentration problems that may last for many months after your
treatments are finished.

In rare cases, heart damage and a higher risk of
other types of cancers, such as
leukemia.

You are younger than 35. Women younger than 35 usually have a more aggressive type of breast
cancer.

Your breast cancer was bigger than a pea. Breast cancers that are at least
1 cm (0.4 in.) are more likely
to come back later.

Your breast cancer has spread to the lymph nodes under your arm. If that's the case, there is a bigger chance that the
cancer may also have spread to other places in your body.

Your doctor may use a genetic test to find your risk for having your cancer come back. Or your doctor may use a computer program, such
as Adjuvant!, to estimate your chances of having your breast cancer come back.
This information can help you and your doctor decide about chemotherapy.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Have chemotherapy after
surgery Have chemotherapy after
surgery

Most
chemotherapy (chemo) medicines are injected into a vein in your hand or arm. This is
called an IV. Sometimes the medicine is a pill that you take at home. Sometimes
it's a combination of the two.

You will go to a hospital or clinic
for each IV treatment, but you won't stay overnight. Treatments last from 10
minutes to an hour or longer.

You have a number of treatments
several weeks apart. A complete course of chemotherapy may take a few months or
a whole year.

Some women need to have a special catheter inserted if it's hard
to find a vein for the IV. This catheter stays in place between
treatments.

Chemo may help
keep breast cancer from coming back.

Breast cancer may come back anyway.

Short-term
side effects may include such things as nausea and vomiting, fatigue, hair loss, and
mouth sores.

Long-term side effects may include early menopause.

Don't have chemotherapy
Don't have chemotherapy

You will have regular
checkups with your doctor to make sure that the cancer hasn't come back.

You avoid the side
effects of chemo.

Depending
on what type of breast cancer you have and how far it has spread, there may be
a higher chance of your cancer coming back.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about choosing chemotherapy for breast cancer

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I was
diagnosed with breast cancer 3 years ago. It was quite a shock. Even though my
breast cancer was small and I did not have any cancer cells in my lymph nodes,
I decided to take chemotherapy. My doctor said that even though it would not
guarantee that the cancer would not come back, it would improve my chances for
a cure. I was really worried about the side effects, but they were not that
bad. I just wanted to do everything in my power to beat this breast cancer. My
checkups have been fine so far, so I think I made the right choice.

Laurel, age
43

I was diagnosed with breast cancer about 3
years after I went through menopause. My breast cancer was small, and I did not
have any cancer in my lymph nodes. I stopped taking my menopause hormones, had
surgery and radiation, and have been taking tamoxifen ever since. I see my
doctor a couple of times a year and so far have been okay. I'm going to ask my
doctor if I'm a good candidate for switching to something like Arimidex. I hear
that it's a smart choice for some women.

Marty, age 56

I found out about my breast cancer
earlier this year. I don't have a family history of it or
any of the risk factors that you read about. I chose to have a
lumpectomy. My doctor had some gene tests done on the tissue that was
removed during my surgery. The tests showed that my cancer was not very
aggressive and that chemotherapy would not be helpful for me. So instead I'm taking letrozole every day. I am glad that there are tests for women with ER+ cancer that can
show if chemo will help.

Brenda, age 57

I got breast cancer 2 years ago. What a surprise! I don't have
any family history (that I know of), and I don't have the other risk factors
that my doctor talked to me about. Fortunately, my breast cancer was really
small, and it hadn't traveled to the lymph nodes under my arm. My doctor
used the Adjuvant! program and said that my chances of the cancer
coming back were small, so I decided not to have the chemo. I keep
in close contact with my doctor and really feel great. I think that passing on
the chemo was the right decision for me.

Janice, age 40

I was
diagnosed with breast cancer just last year. Thank goodness I have been having
those mammograms. My breast cancer was small, and I didn't have any cancer in
the lymph nodes. I stopped taking my menopause hormones, and my doctor
suggested that I try a medication called tamoxifen. I had a few hot flashes,
but nothing bad. I feel really good and continue to see my doctor for checkups.
I will take the tamoxifen for 2 years and then take something else. Who knows
what will be on the market by then?

Paula, age 61

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have chemotherapy after surgery

Reasons not to have chemotherapy

I want to do everything possible to treat my breast cancer.

I would rather wait and see if my cancer comes back before I have more treatment.

More important

Equally important

More important

I would have strong feelings of failure if my breast cancer returned.

I know there's no way to know for sure whether chemo would keep my cancer from coming back.

More important

Equally important

More important

I want to have the added treatment and be done with it.

I would be comfortable having frequent follow-ups, without treatment, to monitor my breast cancer.

More important

Equally important

More important

I feel ready to deal with the possible side effects of chemo.

I am very worried about the side effects.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having chemo

NOT having chemo

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

Is chemo the main treatment for early-stage breast cancer?

YesNo, it's not a main treatment. Chemotherapy is an added treatment, a sort of insurance policy designed to kill any cancer cells that may still be in your body after surgery.

NoYou're right. Chemotherapy is an added treatment, a sort of insurance policy designed to kill any cancer cells that may still be in your body after surgery.

I'm not sureIt may help to go back and read "Get the Facts." Chemo is an added treatment, a sort of insurance policy designed to kill any cancer cells that may still be in your body after surgery.

2.

Should every woman with early-stage breast cancer have chemotherapy?

YesNo, not every woman will need chemo. It depends on what type of breast cancer she has and how far it has spread.

NoYou're right. Not every woman will need chemo. It depends on what type of breast cancer she has and how far it has spread.

I'm not sureIt may help to go back and read "Get the Facts." Not every woman will need chemo. It depends on what type of breast cancer she has and how far it has spread.

3.

Are the side effects of chemo always bad?

YesNo, some women are not bothered by side effects. Your doctor can give you other medicines to help you deal with side effects like nausea and vomiting.

NoThat's right. Some women are not bothered by side effects. Your doctor can give you other medicines to help you deal with side effects like nausea and vomiting.

I'm not sureIt may help to go back and read "Get the Facts." Some women are not bothered by side effects.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Breast Cancer: Should I Have Chemotherapy for Early-Stage Breast Cancer?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Have
chemotherapy after your surgery for early-stage breast
cancer.

Don't have chemotherapy.

Key points to remember

Chemotherapy ("chemo") is often used after surgery for
early-stage breast cancer to help lower the chances that your breast cancer
will come back.

Some women have a very low risk of cancer coming back and don't need chemo. There are gene tests that may show whether having chemo will
help you reduce your chances that the cancer will return.

Your age, type of cancer, tumor size, and hormone
receptor status have an effect on how well chemo will work to keep your cancer
from coming back.

Different medicines used for chemo have different
side effects. Your doctor can give you other medicines to help you deal with
side effects like nausea and vomiting. Some women are bothered a lot by the
side effects, but some aren't.

The drugs used for chemo can be very expensive. Insurance
policies don't always cover the whole cost. If you have no insurance, your
doctor may be able to help you find drug companies or organizations that will
help you pay for this treatment.

FAQs

What is breast cancer?

Breast cancer occurs when abnormal cells grow out of control in one or both
breasts. These cells can invade nearby tissues and form a mass, called a
malignant tumor. The cancer cells can spread (metastasize) to the
lymph nodes and other parts of the body.

When is chemotherapy used to treat early-stage breast cancer?

The first treatment for early-stage breast cancer usually
includes surgery and sometimes
radiation. Your doctor may also talk to you about
added treatment, such as
chemotherapy ("chemo") and
hormone therapy, that may help keep cancer from coming
back.

Some people think of added treatment as an insurance policy
designed to destroy any cancer cells that may still be in the body.

It isn't possible for all women to know for
sure who will benefit from added treatment. But if you have early-stage,
estrogen receptor positive (ER+) breast cancer with no cancer in the lymph
nodes, you may have a gene test. Gene tests, such as the Oncotype DX, may be
done on the cancerous tissue that was removed to look for
tumor markers. These tests can give your doctor
important information about whether chemotherapy will help you.

The type of added treatment you have depends on the
stage and
classification of your breast cancer:

Stage: How far the
cancer has spread in your breast and whether it has spread to nearby tissues or
other organs is called the stage. This is one of the most important things in
choosing the treatment option that is right for you. If breast cancer cells
have spread to your lymph nodes, there is a greater risk that they may also
have spread to other places in your body. Added treatment, including chemo, may
help destroy cancer cells in your body.

Classification: Breast cancer is classified according to what
the cancer cells look like under a microscope. This tells your doctor how fast
the cancer cells are growing and dividing and where they may have started in
the breast tissue. If your cancer cells are growing and dividing quickly, then
chemo may help you. When cancer is the kind that grows quickly, doctors call it
"aggressive" or "poorly differentiated."

What are the risks of chemotherapy?

Different
chemotherapy medicines tend to cause different side effects. Many women do not
have problems with these side effects, while other women are bothered a lot.
There are other medicines you can take to treat the side effects of
chemo.

Talk to your doctor about the type of chemotherapy medicine
that he or she is planning to give you. Ask about any side effects that the
chemo may cause.

Short-term side effects can include:

Nausea and vomiting.

Loss of
appetite.

Fatigue.

Hair thinning or hair loss.

Mouth
sores.

Diarrhea.

Increased chance of bruising,
bleeding, and infection.

Memory and concentration problems.

Long-term side effects of chemotherapy can
include:

Early menopause, which means not being able
to have children anymore. It also can include symptoms like hot flashes,
vaginal dryness, and thinning bones (osteoporosis).

Concentration problems that may last for many months after your
treatments are finished.

In rare cases, heart damage and a higher risk of
other types of cancers, such as
leukemia.

Why might your doctor recommend chemotherapy?

Your
doctor might recommend chemotherapy ("chemo") after surgery if:

You are younger than 35. Women younger than 35 usually have a more aggressive type of breast
cancer.

Your breast cancer was bigger than a pea. Breast cancers that are at least
1 cm (0.4 in.) are more likely
to come back later.

Your breast cancer has spread to the lymph nodes under your arm. If that's the case, there is a bigger chance that the
cancer may also have spread to other places in your body.

Your doctor may use a genetic test to find your risk for having your cancer come back. Or your doctor may use a computer program, such
as Adjuvant!, to estimate your chances of having your breast cancer come back.
This information can help you and your doctor decide about chemotherapy.

2. Compare your options

Have chemotherapy after
surgery

Don't have chemotherapy

What is usually involved?

Most
chemotherapy (chemo) medicines are injected into a vein in your hand or arm. This is
called an IV. Sometimes the medicine is a pill that you take at home. Sometimes
it's a combination of the two.

You will go to a hospital or clinic
for each IV treatment, but you won't stay overnight. Treatments last from 10
minutes to an hour or longer.

You have a number of treatments
several weeks apart. A complete course of chemotherapy may take a few months or
a whole year.

Some women need to have a special catheter inserted if it's hard
to find a vein for the IV. This catheter stays in place between
treatments.

You will have regular
checkups with your doctor to make sure that the cancer hasn't come back.

What are the benefits?

Chemo may help
keep breast cancer from coming back.

You avoid the side
effects of chemo.

What are the risks and side effects?

Breast cancer may come back anyway.

Short-term
side effects may include such things as nausea and vomiting, fatigue, hair loss, and
mouth sores.

Long-term side effects may include early menopause.

Depending
on what type of breast cancer you have and how far it has spread, there may be
a higher chance of your cancer coming back.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.

Personal stories about choosing chemotherapy for breast cancer

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I was diagnosed with breast cancer 3 years ago. It was quite a shock. Even though my breast cancer was small and I did not have any cancer cells in my lymph nodes, I decided to take chemotherapy. My doctor said that even though it would not guarantee that the cancer would not come back, it would improve my chances for a cure. I was really worried about the side effects, but they were not that bad. I just wanted to do everything in my power to beat this breast cancer. My checkups have been fine so far, so I think I made the right choice."

— Laurel, age
43

"I was diagnosed with breast cancer about 3 years after I went through menopause. My breast cancer was small, and I did not have any cancer in my lymph nodes. I stopped taking my menopause hormones, had surgery and radiation, and have been taking tamoxifen ever since. I see my doctor a couple of times a year and so far have been okay. I'm going to ask my doctor if I'm a good candidate for switching to something like Arimidex. I hear that it's a smart choice for some women."

— Marty, age 56

"I found out about my breast cancer earlier this year. I don't have a family history of it or any of the risk factors that you read about. I chose to have a lumpectomy. My doctor had some gene tests done on the tissue that was removed during my surgery. The tests showed that my cancer was not very aggressive and that chemotherapy would not be helpful for me. So instead I'm taking letrozole every day. I am glad that there are tests for women with ER+ cancer that can show if chemo will help."

— Brenda, age 57

"I got breast cancer 2 years ago. What a surprise! I don't have any family history (that I know of), and I don't have the other risk factors that my doctor talked to me about. Fortunately, my breast cancer was really small, and it hadn't traveled to the lymph nodes under my arm. My doctor used the Adjuvant! program and said that my chances of the cancer coming back were small, so I decided not to have the chemo. I keep in close contact with my doctor and really feel great. I think that passing on the chemo was the right decision for me."

— Janice, age 40

"I was diagnosed with breast cancer just last year. Thank goodness I have been having those mammograms. My breast cancer was small, and I didn't have any cancer in the lymph nodes. I stopped taking my menopause hormones, and my doctor suggested that I try a medication called tamoxifen. I had a few hot flashes, but nothing bad. I feel really good and continue to see my doctor for checkups. I will take the tamoxifen for 2 years and then take something else. Who knows what will be on the market by then?"

— Paula, age 61

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have chemotherapy after surgery

Reasons not to have chemotherapy

I want to do everything possible to treat my breast cancer.

I would rather wait and see if my cancer comes back before I have more treatment.

More important

Equally important

More important

I would have strong feelings of failure if my breast cancer returned.

I know there's no way to know for sure whether chemo would keep my cancer from coming back.

More important

Equally important

More important

I want to have the added treatment and be done with it.

I would be comfortable having frequent follow-ups, without treatment, to monitor my breast cancer.

More important

Equally important

More important

I feel ready to deal with the possible side effects of chemo.

I am very worried about the side effects.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having chemo

NOT having chemo

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Is chemo the main treatment for early-stage breast cancer?

Yes

No

I'm not sure

You're right. Chemotherapy is an added treatment, a sort of insurance policy designed to kill any cancer cells that may still be in your body after surgery.

2.
Should every woman with early-stage breast cancer have chemotherapy?

Yes

No

I'm not sure

You're right. Not every woman will need chemo. It depends on what type of breast cancer she has and how far it has spread.

3.
Are the side effects of chemo always bad?

Yes

No

I'm not sure

That's right. Some women are not bothered by side effects. Your doctor can give you other medicines to help you deal with side effects like nausea and vomiting.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

Yes

No

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2.
Check what you need to do before you make this decision.

I'm ready to take action.

I want to discuss the options with others.

I want to learn more about my options.

3.
Use the following space to list questions, concerns, and next steps.

Credits

By

Healthwise Staff

Primary Medical Reviewer

Sarah Marshall, MD - Family Medicine

Specialist Medical Reviewer

Douglas A. Stewart, MD - Medical Oncology

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